# Crisis Protocol — Welfare Check, 72-Hour Hold, ROI (v0.1 DRAFT)

**Status:** DRAFT | **Source:** 05-02 strategic call + debrief call (Erin case)

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## Activation triggers

Crisis protocol activates when ANY of:
1. Client expresses suicidal ideation with intent or plan
2. Client refuses to confirm safety on a scheduled check-in (silence + non-response)
3. Client makes credible threats of self-harm or harm to others
4. Third party (family, neighbour, landlord) reports a credible safety concern
5. Client is involuntarily admitted (hospital calls case manager)

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## Phase 1 — Welfare check (within minutes)

1. Case manager attempts a recorded voice call with the client.
2. If client confirms safety AND a safety plan can be agreed → de-escalate, document, follow-up within 4 hours.
3. If client cannot confirm safety OR refuses to engage → case manager calls 911 from a recorded line:
   - State: "I am [name], a case manager for [client name] at [client address]. I have credible evidence of suicidal ideation / self-harm threat. I'm requesting a welfare check."
   - Have the client's exact address, DOB, and current emotional state ready.
   - Have the recording cued and ready to share with officers if they ask for evidence.
4. **Keep the case-manager-to-client recording running** through the welfare check. This was the pivot in Erin's case — without the recording, police were going to leave.
5. Case manager does **not** drive to the scene during a welfare check unless explicitly invited by responding officers (avoid "plant for the parents" perception risk).

## Phase 2 — Hospital admission (hours 1-24)

1. Once client is in ER, case manager calls the hospital and identifies as case manager. Asks for charge nurse / case manager.
2. **Verifies whether ROI is on file.** If not: any information sharing is blocked.
3. If client signed ROI at intake (covering hospital scenarios): case manager can receive updates.
4. Case manager records the call with hospital staff (one-party consent, business call).
5. Case manager files an **incident report** for the family — first draft within 4 hours of admission. Use the Erin incident report (`/clinical/case-studies/erin-w-2026-05/docs/Avina_Incident_Report_EW_2026-05-01.pdf`) as the format reference.
6. Case manager **must visit client in person** during the hold (per Erin debrief: failing to visit is a trust break that doesn't recover).

## Phase 3 — 72-hour hold (days 1-3)

1. Daily check-ins with hospital case manager.
2. Daily updates to family.
3. Pre-arrange: where does client go after the hold?
   - Option A: voluntary transition to specialised treatment program (preferred — see treatment-program criteria below).
   - Option B: discharged home with intensive outpatient.
   - Option C: extended hold if hospital deems necessary.
4. Discuss treatment-program transition with client during in-person visits — frame it as the **better option vs. staying in hospital ("inpatient will seem like paradise compared to ER")**.

## Phase 4 — Treatment program transition (days 3+)

1. Coordinate direct transfer from hospital to treatment program (no in-between).
2. Client signs program-specific ROI for case manager continuity.
3. Treatment programs typically restrict outside contact — case manager respects the "bubble" rule.
4. Visits may be limited to one day per week (e.g., Saturdays only).
5. Case manager remains liaison with family + hospital + program.

## Phase 5 — Documentation throughout

Every interaction recorded. Every document collected. **No off-the-record conversations during a crisis.**
- Hospital phone calls: recorded
- Family updates: incident-report style, written
- Client visits: post-visit summary written within 1 hour, voice-noted with PLAUD
- Police interactions: recorded if legally permissible; otherwise contemporaneous notes within 30 minutes

## Phase 6 — Liability and exposure management

- Case manager calls all communications from a number associated with Avina (not personal phone) where possible.
- All written communications use the Avina email signature with disclaimer.
- Liability insurance must be active and current — verify before any engagement (Avina to confirm coverage limits).
- Any "plant for the parents" perception risk: case manager keeps a clean documentation trail showing decisions are driven by client safety, not family interest.

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## What was NOT done correctly in the Erin case (lessons)

1. ✅ Recording WAS made during escalation — this saved the welfare check.
2. ❌ ROI was not pre-signed → information flow with hospital was bottlenecked.
3. ❌ Liability insurance not confirmed active before engagement.
4. ❌ State-by-state recording law not pre-vetted (Erin in [state] — need to confirm one-party legality).
5. ❌ Family communication was reactive, not pre-scripted.
6. ✅ Incident report was drafted same-day → format becomes our template.

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## Revision log

- v0.1 — 2026-05-02 — Initial protocol from strategic + debrief calls